Search PubMed⌕ Search

Biomedical subjects

D W Roberts

Publications and source records attributed to D W Roberts.

At least 55 records · Page 3Linked to original sources

A computational model for tracking subsurface tissue deformation during stereotactic neurosurgery.

Recent advances in the field of stereotactic neurosurgery have made it possible to coregister preoperative computed tomography (CT) and magnetic resonance (MR) images with instrument locations in the operating field. However, accounting for intraoperative movement of brain tissue remains a challenging problem. While intraoperative CT and MR scanners record concurrent tissue motion, there is motivation to develop methodologies which would be significantly lower in cost and more widely available. The approach we present is a computational model of brain tissue deformation that could be used in conjunction with a limited amount of concurrently obtained operative data to estimate subsurface tissue motion. Specifically, we report on the initial development of a finite element model of brain tissue adapted from consolidation theory. Validations of the computational mathematics in two and three dimensions are shown with errors of 1%-2% for the discretizations used. Experience with the computational strategy for estimating surgically induced brain tissue motion in vivo is also presented. While the predicted tissue displacements differ from measured values by about 15%, they suggest that exploiting a physics-based computational framework for updating preoperative imaging databases during the course of surgery has considerable merit. However, additional model and computational developments are needed before this approach can become a clinical reality.

Animals↗

Model-updated image guidance: initial clinical experiences with gravity-induced brain deformation.

Image-guided neurosurgery relies on accurate registration of the patient, the preoperative image series, and the surgical instruments in the same coordinate space. Recent clinical reports have documented the magnitude of gravity-induced brain deformation in the operating room and suggest these levels of tissue motion may compromise the integrity of such systems. We are investigating a model-based strategy which exploits the wealth of readily-available preoperative information in conjunction with intraoperatively acquired data to construct and drive a three dimensional (3-D) computational model which estimates volumetric displacements in order to update the neuronavigational image set. Using model calculations, the preoperative image database can be deformed to generate a more accurate representation of the surgical focus during an operation. In this paper, we present a preliminary study of four patients that experienced substantial brain deformation from gravity and correlate cortical shift measurements with model predictions. Additionally, we illustrate our image deforming algorithm and demonstrate that preoperative image resolution is maintained. Results over the four cases show that the brain shifted, on average, 5.7 mm in the direction of gravity and that model predictions could reduce this misregistration error to an average of 1.2 mm.

Adolescent↗

Localized pain associated with seizures originating in the parietal lobe.

PURPOSE: Ictal pain is a rare symptom of seizures. Epileptic pain may be experienced unilaterally (lateral/ peripheral), cephalically, or in the abdomen. Painful seizures have been associated with seizure origin in both the parietal and the temporal lobes. We report on the different types of epileptic pain and discuss its etiology and possible localizing value. METHODS: We reviewed the records of patients referred to our epilepsy program over the last 6 years. Eight (1.4%) of 573 patients had pain as an early prominent symptom of their seizures. RESULTS: Pain was predominantly unilateral in three patients, cephalic in two, and abdominal in three patients. Seizure onset was in or involving the parietal lobe in all patients, and when the painful symptoms were lateralized, they were contralateral to the side of seizure origin. Parietal lobe seizure origin was determined by both intracranial EEG recording and neuroimaging [magnetic resonance imaging (MRI), ictal single photon emission computed tomography (SPECT)] in five patients, and by both scalp EEG and neuroimaging in three patients. CONCLUSIONS: We conclude that ictal pain is a rare symptom of parietal lobe seizure origin with lateralizing potential.

Abdominal Pain↗

Structure-activity relationships in the murine local lymph node assay for skin sensitization: alpha,beta-diketones.

The biological activity of skin-sensitizing chemicals is related to their ability to react, either directly or after metabolic activation, with appropriate skin proteins. For direct acting electrophilic compounds, this ability can be modelled, using the RAI (relative alkylation index) approach, by a combination of electrophilicity and hydrophobicity parameters. Several structure-activity relationships based on this approach have been reported, but most of them cover guinea pig sensitization test data on what chemists would classify as relatively soft electrophilic chemicals. In the present work, an electrophilicity parameter based on Taft substituent constants is derived for hard electrophiles having a reactive carbonyl group, and is used to calculate RAI values for the analysis of sensitization test data obtained in the murine local lymph node assay (LLNA) for a series of alpha, beta-diketones. The sensitization potential of these reactive hard electrophilic carbonyl compounds in the LLNA shows a good correlation with the RAI. Overall, the findings reaffirm our view that physical organic chemistry is the key to understanding why some chemicals sensitize more strongly than others, while some do not sensitize at all, and provide further evidence of the value of the LLNA for SAR studies.

Animals↗

Utilization of impedance measurements in pallidotomy using a monopolar electrode.

OBJECT: This study was performed to evaluate the reliability and utility of using monopolar impedance monitoring for estimation of the location of the thermocouple electrode during a pallidotomy procedure. METHODS: In 26 patients, impedance profiles were measured at 2-mm intervals and anatomical boundaries were marked on postoperative MRI studies in 19 patients. The pattern of change in impedance as the electrode was towards the target coordinates in the globus pallidus was studied empirically in relation to MRI-defined anatomy and by electrical stimulations. The pattern of impedance change was of greater reliability than absolute impedance values. A drop in impedance was noted in 10 cases where the electrode entered the putamen or globus pallidus upon exiting the internal capsule, and in 9 of these this drop was measured before or at the distal boundary of the internal capsule. A variable pattern in the region of the base of the globus pallidus was observed, with 10 of 19 cases demonstrating a decrease and 8 cases an increase, consistent with the proximity of a CSF cistern in the former and the ansa lenticularis and optic tract in the latter. Simulations showed that the monopolar electrode was more sensitive to the approach of a boundary than the bipolar electrode. CONCLUSION: Our measurements and simulations suggest that a monopolar electrode could predict a nearby region of high or low impedance before penetrating it and a trend of decreasing impedance as the distal edge of the globus pallidus is approached.

Computer Simulation↗

Updated neuroimaging using intraoperative brain modeling and sparse data.

A strategy to update preoperative imaging for image-guided surgery using readily available intraoperative information has been developed and implemented. A patient-specific three-dimensional finite element model of the brain is generated from preoperative MRI and used to simulate deformation resulting from multiple surgical processes. Intraoperatively obtained sparse imaging data, such as from digital cameras or ultrasonography, is then used to prescribe the displacement of selected points within the model. Interpolation to the resolution of preoperative imaging may then be performed based upon the model. The algorithms for generation of the finite element model and for its subsequent deformation have been successfully validated using a pig brain model, and preliminary clinical application in the operating room has demonstrated feasibility.

Algorithms↗

Long-term seizure outcome following corpus callosotomy in children.

INTRODUCTION: The long-term outcome of pediatric patients undergoing corpus callosotomy (CC) for palliative control of medically intractable seizures is presented. METHODS: During a 27-year period, 43 patients, 20 years of age or younger, underwent CC for seizure palliation and had a minimum of 1 year follow-up. Seizure reduction and stability of that outcome for individual seizure types and for most disabling seizure were reviewed. RESULTS: Overall, 63% of the seizures documented showed a good response. For the most disabling seizure, 56% of the patients had good outcomes. Changes in outcome status occurred within the first 6 months, and outcome was largely maintained after that point. CONCLUSION: Callosotomy achieves the goal of seizure palliation in more than half of the patients, with stable, good outcomes being maintained in the majority of patients.

Adolescent↗

Coregistered ultrasound as a neurosurgical guide.

INTRODUCTION: The dynamic nature and three dimensionality of ultrasound data can be utilized to enhance the capabilities of image guidance systems. METHODS: Coregistration of ultrasound data was done using an electromagnetic digitizer, and subsequent ultrasound images were correlated with preoperative MRI studies. Thirty-two patients undergoing craniotomy were investigated in this manner. RESULTS: Phantom testing done with a rigid stylus and 3D ultrasound tracker demonstrated an accuracy of 1.36 +/- 1.67 mm in determining the location of a point. Thirty-two clinical cases were coregistered without difficulty. CONCLUSION: Coregistered ultrasound is a useful methodology that can aid in neuronavigation.

Brain↗

Gamma Knife radiosurgery relative to microsurgery: epilepsy.

There is a strong rationale for investigation of the role of Gamma Knife radiosurgery in the treatment of medically intractable epilepsy. To explore this potential application, the well established and highly successful current outcomes associated with microsurgical treatment were reviewed, and include for temporal resections seizure-free results in 65-70% of patients, with permanent morbidity of less than 5% and mortality less than 1%. Advantages of open surgery include the opportunity to conduct electrocorticography and functional mapping, excellent visualization enabling an assured and discrete line of resection, freedom in general from volume constraints, and immediate efficacy. The preliminary evidence in support of radiosurgical treatment includes several series of patients with epilepsy associated with arteriovenous malformation, tumor, or cavernous anginoma in which results approaching those of surgery have been achieved. In a series of 15 patients with mesial temporal sclerosis, all but one patient with follow-up of at least one year are seizure-free; morbidity has been limited to one asymptomatic field defect. A series of ten patients with epilepsy associated with hypothalamic hamartoma has achieved seizure improvement in six of eight patients with at least one year follow-up, and no major morbidity has been seen. Radiosurgical treatment for intractable epilepsy appears to be effective in a majority of patients and can be performed safely and efficiently. Early experimental evidence suggests that seizure control might in some instances be achievable without ablation of the pathological target.

Epilepsy↗

Intraoperatively updated neuroimaging using brain modeling and sparse data.

OBJECTIVE: Image-guided neurosurgery incorporating preoperatively obtained imaging information is subject to spatial error resulting from intraoperative brain displacement and deformation. A strategy to update preoperative imaging using readily available intraoperative information has been developed and implemented. METHODS: Preoperative magnetic resonance imaging is used to generate a patient-specific three-dimensional finite element model of the brain by which deformation resulting from multiple surgical processes may be simulated. Sparse imaging data obtained subsequently, such as from digital cameras or ultrasound, are then used to prescribe the displacement of selected points within the model. Based on the model, interpolation to the resolution of preoperative imaging may then be performed. RESULTS: The algorithms for generation of the finite element model and for its subsequent deformation were successfully validated using a pig brain model. In these experiments, the method recovered 84% of the intraoperative shift resulting from surgically induced tissue motion. Preliminary clinical application in the operating room has demonstrated feasibility. CONCLUSION: A strategy by which intraoperative brain deformation may be accounted for has been developed, validated in an animal model, and demonstrated clinically.

Adult↗

Intraoperative brain shift and deformation: a quantitative analysis of cortical displacement in 28 cases.

OBJECTIVE: A quantitative analysis of intraoperative cortical shift and deformation was performed to gain a better understanding of the nature and extent of this problem and the resultant loss of spatial accuracy in surgical procedures coregistered to preoperative imaging studies. METHODS: Three-dimensional feature tracking and two-dimensional image analysis of the cortical surface were used to quantify the observed motion. Data acquisition was facilitated by a ceiling-mounted robotic platform, which provided a number of precision tracking capabilities. The patient's head position and the size and orientation of the craniotomy were recorded at the start of surgery. Error analysis demonstrated that the surface displacement measuring methodology was accurate to 1 to 2 mm. Statistical tests were performed to examine correlations between the amount of displacement and the type of surgery, the nature of the cranial opening, the region of the brain involved, the duration of surgery, and the degree of invasiveness. RESULTS: The results showed that a displacement of an average of 1 cm occurred, with the dominant directional component being associated with gravity. The mean displacement was determined to be independent of the size and orientation of the cranial opening. CONCLUSION: These data suggest that loss of spatial registration with preoperative images is gravity-dominated and of sufficient extent that attention to errors resulting from misregistration during the course of surgery is warranted.

Adult↗

Isolation of a cDNA encoding a novel subtilisin-like protease (Pr1B) from the entomopathogenic fungus, Metarhizium anisopliae using differential display-RT-PCR.

Reverse transcription differential display PCR (RT-DD-PCR) was used to identify genes that are specifically expressed by Metarhizium anisopliae when it contacts the host insect cuticle. Using a homology-based subtilisin-like protease primer we identified a hitherto unsuspected differentially expressed subtilisin-like protease (Pr1B) encoding gene. The deduced amino acid sequence shows 54% similarity to the well characterized Pr1A subtilisin of M. anisopliae and karyotype analysis revealed that Pr1A and Pr1B are located on separate chromosomes. Like Pr1A, Pr1B is synthesized as a large precursor (1158 nucleotides; deduced molecular mass = 40031 Da) containing a signal peptide, a propeptide and the mature protease (283 aa; deduced molecular mass = 28714 Da). However, Pr1B possesses several substitutions in the highly conserved sequences comprising the active sites of subtilisins. In particular, the substitution of Thr220 by serine is unique to Pr1B. Substitution of Asn155 by glycine is also very unusual, and we discuss the likely effects these changes will have on the catalytic efficiency of Pr1B.

Amino Acid Sequence↗

Immunochemical, 32P-postlabeling, and GC/MS detection of 4-aminobiphenyl-DNA adducts in human peripheral lung in relation to metabolic activation pathways involving pulmonary N-oxidation, conjugation, and peroxidation.

4-Aminobiphenyl (ABP) is a recognized human bladder carcinogen, whose presence in cigarette smoke results in DNA adduct formation in the human urothelium. Since preliminary studies indicated that even higher levels of ABP-DNA adducts may be present in human peripheral lung, we utilized a sensitive immunochemical assay, in combination with 32P-postlabeling, to quantify the major 4-aminobiphenyl (ABP)-DNA adduct, N-(guan-8-yl)-ABP, in surgical samples of peripheral lung tissue from smokers and ex-smokers. No differences in adduct levels were detected between smokers and ex-smokers by immunoassay. In contrast, the 32P-postlabeling method showed statistically significant differences between adduct levels in smokers and ex-smokers; however, a relatively high background of smoking-related adducts chromatograph near the major ABP adducts and may compromise estimation of the level of ABP-DNA adducts in smokers. Furthermore, the levels measured by 32P-postlabeling were 20- to 60-fold lower than that measured by immunoassay. Since 32P-postlabeling may underestimate and immunochemical assays may overestimate adduct levels in the lung, selected samples were also evaluated by GC/MS. The immunochemical and GC/MS data were concordant, leading us to conclude that N-(guan-8-yl)-ABP adducts were not related to smoking status. Since ABP-DNA adduct levels in human lung did not correlate with smoking status as measured by immunoassay and GC/MS, the metabolic activation capacity of human lung microsomes and cytosols was examined to determine if another exposure (e.g., 4-nitrobiphenyl) might be responsible for the adduct. The rates of microsomal ABP N-oxidation were below the limit of detection, which was consistent with a lack of detectable cytochrome P4501A2 in human lung. N-Hydroxy-ABP O-acetyltransferase (but not sulfotransferase) activity was detected in cytosols and comparative measurements of N-acetyltransferase (NAT) using p-aminobenzoic acid and sulfamethazine indicated that NAT1 and NAT2 contributed to this activity. 4-Nitrobiphenyl reductase activity was found in lung microsomes and cytosols, with the reaction yielding ABP and N-hydroxy-ABP. Lung microsomes also demonstrated high peroxidative activation of ABP, benzidine, 4,4'-methylene-bis(2-chloroaniline), 2-aminofluorene, and 2-naphthylamine. The preferred co-oxidant was hydrogen peroxide and the reaction was strongly inhibited by sodium azide but not by indomethacin or eicosatetraynoic acid, which suggested the primary involvement of myeloperoxidase rather than prostaglandin H synthase or lipoxygenase. This was confirmed by immunoinhibition and immunoprecipitation studies using solubilized human lung microsomes and antisera specific for myeloperoxidase. These data suggest that ABP-DNA adducts in human lung result from some environmental exposure to 4-nitrobiphenyl. The bioactivation pathways appear to involve: (1) metabolic reduction to N-hydroxy-ABP and subsequent O-acetylation by NAT1 and/or NAT2; and (2) metabolic reduction to ABP and subsequent peroxidation by myeloperoxidase. The myeloperoxidase activity appears to be the highest peroxidase activity measured in mammalian tissue and is consistent with the presence of neutrophils and polymorphonuclear leukocytes surrounding particulate matter derived from cigarette smoking.

Acyltransferases↗

Neurocognitive and psychosocial correlates of ventroposterolateral pallidotomy surgery in Parkinson's disease.

The purpose of this study was to characterize the neuropsychological and psychosocial profile of patients with Parkinson's disease before and after they underwent unilateral left or right pallidotomy, to assess specific cognitive and personality changes caused by lesioning the globus pallidus, and to predict favorable surgical outcome based on these measures. Eighteen patients underwent comprehensive neuropsychological assessment before and after left-sided pallidotomy (10 patients) or right-sided pallidotomy (eight patients). The findings support the presence of frontosubcortical cognitive dysfunction in all patients at baseline and a specific pattern of cognitive impairment following surgery, with side of lesion being an important predictor of pattern and degree of decline. Specifically, patients who underwent left-sided pallidotomy experienced a mild decline on measures of verbal learning and memory, phonemic and semantic verbal fluency, and cognitive flexibility. Patients who underwent right-sided pallidotomy exhibited a similar decline in verbal learning and cognitive flexibility, as well as a decline in visuospatial construction abilities; however, this group also exhibited enhanced performance on a delayed facial memory measure. Lesioning the globus pallidus may interfere with larger cognitive circuits needed for processing executive information with disruption of the dominant hemisphere circuit, resulting in greater deficits in verbal information processing. The left-sided pallidotomy group also reported fewer symptoms of depression and anxiety following surgery. This enhanced mood functioning was not seen for the right-sided pallidotomy group. No relationships were noted between cognitive impairment or advanced age at baseline and surgicaloutcome. This study provides objective evidence for specific changes in neurocognitive and psychosocial functioning following left- and right-sided pallidotomy.

Journal Article↗

Comparison of covalent binding of acetaminophen and the regioisomer 3'-hydroxyacetanilide to mouse liver protein.

The hepatotoxicity of the analgesic acetaminophen has been previously attributed to metabolic activation by cytochrome P450 to the reactive intermediate N-acetyl-p-benzoquinone imine. At therapeutic doses this species is detoxified by reaction with glutathione; however, following a hepatotoxic dose, liver glutathione levels are depleted and the metabolite covalently binds primarily to cysteine groups on proteins as 3-(cystein-S-yl)acetaminophen adducts. Altered function of critical proteins has been postulated to be the mechanism of hepatotoxicity. Covalent binding has been studied by both radiochemical methods and immunochemical methods. Utilizing Western blot analysis with an antiserum which recognizes acetaminophen we have previously shown that covalent binding occurs on a number of proteins in various hepatic fractions. In an effort to better understand the role of covalent binding in the toxicity, others have studied the non-hepatotoxic isomer 3'-hydroxyacetanilide. Administration of large doses of radiolabeled acetaminophen or 3'-hydroxyacetanilide resulted in similar levels of covalent binding to proteins. To better understand the role of covalent binding in toxicity we have administered mice 3'-hydroxyacetanilide and acetaminophen, and analyzed liver fractions for protein adducts using anti-3-(cystein-S-yl)acetaminophen and anti-arylacetamide antisera in Western blot assays. Analysis of liver fractions from acetaminophen-treated mice, with both antisera showed, as has been previously reported, that acetaminophen covalently binds to a number of hepatic proteins. In liver from 3'-hydroxyacetanilide-treated mice, covalent adducts were detected with an anti-arylacetamide antiserum only. A major 3'-hydroxyacetanilide protein adduct was observed in microsomes at 50 kDa. Minor adducts were observed at 47 kDa in microsomes and 56 kDa in cytosol. 3'-Hydroxyacetanilide protein adducts were not observed in the 10,000 x g pellet. Densitometric analysis of a time course of 3'-hydroxyacetanilide protein adducts indicated that peak levels of the 50 kDa microsomal protein adduct occurred at 1 h and subsequently decreased.

Acetaminophen↗

Skin sensitization to eugenol and isoeugenol in mice: possible metabolic pathways involving ortho-quinone and quinone methide intermediates.

With the aim of providing further mechanistic insights into the mode of action of eugenol (4-allyl-2-methoxyphenol) and isoeugenol (4-propenyl-2-methoxyphenol), we have synthesized two series of modified compounds which were tested in the mouse local lymph node assay for their skin sensitizing potential. The replacement of the methoxy group by an isopropoxy group led to a complete loss of sensitization for the eugenol derivative 6a, while no significant effect was observed for the isoeugenol derivative 6b. In the eugenol series, when methyl groups were present in the 3-, 5-, or 6-position a significant reduction in sensitization potential was observed while in the isoeugenol series only methyl substitution in the 3- and 5-position had a discernable effect. Introduction of three methyl groups on the aromatic ring of eugenol (3,5,6-trimethyl-4-allyl-2-methoxyphenol, 7) and of a tert-butyl substituent at the gamma-position of the alkyl chain of isoeugenol (4-[3',3',3'-trimethylpropenyl]-2-methoxyphenol, 8) led to a strong decrease of the sensitizing capacity. Our findings indicate that, at least in the mouse, eugenol could sensitize via a demethylation pathway followed by oxidation to the o-quinone which could act directly as a hapten even if we cannot exclude a reaction via its tautomeric p-quinone methide. Isoeugenol, on the other hand, could act via a mechanism not involving demethylation and for which the evidence is consistent with a direct oxidation to the p-quinone methide.

Animals↗

Molecular orbital parameters as predictors of skin sensitization potential of halo- and pseudohalobenzenes acting as SNAr electrophiles.

The electrophilic reactivity of a training set of 20 halo- and pseudohalobenzenes, 10 of which are reported skin sensitizers and 10 of which are reported nonsensitizers, has been modeled by MO-calculated indices using the AM1 and PM3 Hamiltonians. The electronic structures of parent molecules and the corresponding Meisenheimer intermediates (sigma-complexes) were evaluated. The NH2 group and the H atom were both studied as model nucleophile-derived substituents in the sigma-complexes. The LUMO energy differences between the parent compounds and their Meisenheimer complexes together with the maximum acceptor superdelocalizabilities determined over the aromatic reaction sites were found to discriminate correctly the sensitizing/reactive from nonsensitizing/unreactive compounds of the training set of 20 compounds. The predictive applicability of these MO indices was confirmed with a test set of seven further compounds for which sensitization data are reported in the literature. A statistically based discriminant analysis provides a model which predicts whether or not an SNAr electrophile will be a sensitizer and estimates the degree of confidence in the prediction.

Aniline Compounds↗

Further evaluation of the quantitative structure-activity relationship for skin-sensitizing alkyl transfer agents.

The biological activity of skin-sensitizing chemicals can be expressed in terms of physicochemical properties which relate to the propensity of those chemicals to behave as electrophiles and which describe their ability to partition into the epidermis and between compartments within it. For defined series of chemicals, it has proved possible to express such structure-activity relationships quantitatively. Such quantitative relationships can provide valuable insights into the mechanisms of skin sensitization and/or are of use in predictive toxicology. In the present work the quantitative structure-activity relationship (QSAR) previously derived for a series of alkyl transfer agents based on alkanesulfonate leaving groups has been critically examined in the light of skin sensitization data obtained for new members of that series and also for alkyl transfer agents based on different leaving groups. The QSAR predictions were broadly accurate, but demonstrated that further refinement was both necessary and possible. In particular, the physicochemical parameters which relate to the disposition of the chemical in the epidermis, i.e., its penetration through the stratum corneum, cell surface/cytoplasmic distribution and the associated dynamics, will need to be understood more fully in order to enhance the precision of the QSAR and its predictive power.

Alkanesulfonates↗